Classifications

• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
  • G01N33/6887—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids from muscle, cartilage or connective tissue
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
  • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10S436/00—Chemistry: analytical and immunological testing
  • Y10S436/811—Test for named disease, body condition or organ function
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
  • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
  • Y10T436/00—Chemistry: analytical and immunological testing
  • Y10T436/14—Heterocyclic carbon compound [i.e., O, S, N, Se, Te, as only ring hetero atom]
  • Y10T436/145555—Hetero-N
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
  • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
  • Y10T436/00—Chemistry: analytical and immunological testing
  • Y10T436/14—Heterocyclic carbon compound [i.e., O, S, N, Se, Te, as only ring hetero atom]
  • Y10T436/145555—Hetero-N
  • Y10T436/146666—Bile pigment
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
  • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
  • Y10T436/00—Chemistry: analytical and immunological testing
  • Y10T436/14—Heterocyclic carbon compound [i.e., O, S, N, Se, Te, as only ring hetero atom]
  • Y10T436/145555—Hetero-N
  • Y10T436/147777—Plural nitrogen in the same ring [e.g., barbituates, creatinine, etc.]

Definitions

• This invention relates to measuring severity of periodontal and peri-implant disease.
• Periodontal and peri-implant disease activity presently are diagnosed by clinical parameters such as pocket depth, bleeding on probing, and radiographs. These parameters have limitations in that they lack ability to predict future attachment loss, and provide information only on the existence of past disease activity. The need for diagnostics in periodontology which are predictive markers of active periodontitis is a focus of present research.
• Periodontal disease is a general term used to describe specific diseases that affect the gingiva, as well as the supporting connective tissues and alveolar bone which anchor the teeth in the jaws.
• the periodontal diseases are among the most common infectious diseases in humans.
• periodontal disease leading to tooth loss has assumed even greater importance.
• As more teeth are retained due to reduced caries, more teeth are at risk to be affected by periodontal disease Shaw, J.H. , N.Eng.J.Med. (1987) 317:996; Williams, R.C., N.Eng.J.Med. (1990) 332:373) .
• the recognition and diagnosis of periodontal disease has become even more important.
• Collagen makes up approximately 90% of the organic matrix of bone.
• Collagen type I is the most abundant collagen of osseous tissues (Deftos, L.J. , Clin. Chem. (1991) 3_7:1143). Following procollagen biosynthesis and its release into the maturing extracellular matrix, collagen molecules form crosslinks which provide additional mechanical stability to the matrix (Miyahara, M. et al. ,
• ICTP Pyridinoline crosslinked carboxy terminal telopeptide of type I collagen
• ICTP Pyridinoline crosslinked carboxy terminal telopeptide of type I collagen
• ICTP is liberated during the degradation of type I collagen.
• ICTP is found in an immunochemically intact form in blood, where it appears to be derived from bone resorption.
• ICTP crosslink contains three peptides, the principal one of which is the carboxy-terminal telopeptide of the ⁇ l(I) chain, which is considerably smaller than the ICTP peptide determined from SDS-PAGE (Risteli, J. et al. , Clin.Chem. (1993), 39:635) .
• Collagen also serves as precursor for another class of pyridinoline crosslinks: cross-linked N- telopeptides of type I collagen (NTP) (found on the N- terminal end of the original collagen type I molecule) , hydroxylysylpyridinoline, (pyridinoline or HP) and lysylpyridinoline (deoxypyridinoline or LP) which are measurable in urine (Seyedin S.M. et al. , J.Bone Miner.Res. (1993), 8 . :635; Gertz, B.J. et al., J.Bone Miner.Res. (1994), 9:135; Eriksen, E.F. et al. (1993), J.Bone Miner.Res., J3:127).
• NTP type I collagen
• HP hydroxylysylpyridinoline
• lysylpyridinoline deoxypyridinoline or LP
• the invention features a method of determining the progression of periodontal disease or peri-implant disease in a human patient, involving obtaining a sample of tissue, fluid, or gingival crevicular fluid from the mouth or a sample of blood or urine of the patient, and measuring pyridinoline crosslinks as a measure of disease progression.
• a level of greater than 50 ng/ml of ICTP in gingival crevicular fluid ("GCF") or more preferably 100 ng/ml or 50 pg/sample site is indicative of disease.
• a level of 6 ng/ml or greater in the peripheral blood or more preferably 10 ng/ml of ICTP is indicative of disease.
• a level of 100 pmol/ ⁇ mol creatinine of NTP in urine is indicative of disease; and a level of 150 nmol/ ⁇ mol creatinine of HP or LP is indicative of disease.
• a level of 100 p ol of NTP in GCF or blood is indicative of disease; and a level of 150 ⁇ mol of " HP or LP is indicative of disease.
• the invention provides a quantitative measure of periodontal disease, and in addition can detect incipient and early stage disease, and not just advanced disease as current clinical techniques do.
• the method of the invention allows not just the detection and quantification of disease, but also permits precise localization of disease, so that treatment can be targeted to the tissues most severely affected.
• Drawings Fig. 1 is a graph demonstrating the correlation between periodontitis and ICTP crosslink in crevicular fluid.
• Fig. 2 is a graph showing the difference in bone metabolic activity by 99mTc-MDP uptake in healthy vs. periodontitis sites in dogs.
• Fig. 3 is a graph demonstrating the correlation between periodontitis and circulating ICTP crosslink.
• Fig. 4 is a graph demonstrating the correlation between circulating ICTP crosslink and periodontitis.
• GCF is a secretion which is exuded from the sulcus between gum and tooth. When first formed, GCF does not mix with the saliva in the mouth, but only does so after it leaves the sulcus and enters the oral cavity. In collecting GCF for analysis according to the invention, it is desirable to minimize dilution of GCF with saliva. Thus the saliva in the vicinity of the sulcus from which GCF is to be collected is removed, preferably using cotton rolls in combination with compressed air, which is blown over the region.
• GCF is collected by placement of a strip of porous material such as ethylcellulose filter paper into the sulcus and maintaining that material in the sulcus for about 30 seconds.
• the strip is inserted into the sulcus until slight resistance is detected.
• fluid volume is measured using a Peritron 6000 TM measuring instrument or other similar device.
• the collected fluid is eluted from the filter strip using phosphate buffered saline containing proteinase inhibitors. Samples are stored frozen until needed for analysis.
• samples Prior to analysis, samples are allowed to thaw at room temperature and they are then assayed for ICTP crosslink by any conventional technique, such as radioimmunoassay (RIA) or some other standard detection method, e.g., ELISA.
• RIA radioimmunoassay
• ELISA ELISA
• Dogs (two one-year old male beagles) are used to assess the measurement of ICTP crosslink as a marker of periodontal disease activity.
• the left quadrants randomly serve as the experimental sites, while the right quadrants serve as control sites. Both animals receive an oral prophylaxis 14 days prior to initiation of the studies.
• the dogs are exposed to the following procedures.
• Subtraction radiographic measurements are taken at the beginning of the ligature induced periodontitis period, denoted as baseline, and again at 2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 16 weeks, and 6-months after onset of periodontitis, in both the experimental and control sites.
• both the experimental and control sites also have ICTP crosslink sample measurements taken.
• There are 6 teeth/half-mouth x 2 sides/dog 3 sample sites/tooth a total of 18 control sites and 18 experimental sites.
• GCF Gingival Crevicular Fluid
• GCF is collected from the mesial, buccal and distal locations of the first premolar through fourth premolar in each quadrant from both dogs.
• the GCF is collected as described above with methylcellulose strips, and the volume determined with a Periotron 6000 TM .
• Samples are placed in 1 mL Eppendorf vials in a solution containing 55 ⁇ l of proteinase inhibitors (15 nM aprotenin and 1 mM phenylmethylsulfonylfluoride (PMSF) ) in phosphate buffered saline (PBS), pH 7.4.
• the fluid is subsequently stored on ice, followed by elution from the collection device for a period of 60 minutes at 25°C.
• the samples are then stored at -20 to -80°C until needed for ICTP crosslink analysis.
• ICTP Crosslink Analysis ICTP Crosslink Analysis
• Frozen samples are allowed to thaw at room temperature for subsequent analysis of ICTP crosslink by RIA (Risteli, J. et al., Clin.Chem. (1993), 39:635-640) . All samples and reagents are allowed to come to room temperature. The samples and standards are set up in duplicate in 12 x 75 mm test tubes. Samples are aliquoted into tubes and 200 ⁇ L of rabbit anti-ICTP is added to each sample. 200 ⁇ L of [ 125 I]ICTP is added to all samples followed by mixing and incubation for 2 hours at 37°C.
• the radiographs are then analyzed with a computer assisted method as follows:
• the radiographs were converted into subtraction images using a closed- circuit video system (GE model 4TE5) camera coupled to an analog digital converter capable of storing an entire video frame in solid-state memory in one time frame (1/30 s) .
• a digital frame grabber (Imaging Technologies, PC Vision Frame Grabber) is capable of digitizing and storing image frames and has an information capacity of more than two million bits (512 x 512 pixels by 8 bits deep) utilizing an IBM PC ATTM as the central processing unit.
• the images are placed in spatial register with the aid of a micromanipulator capable of orthogonal movement in two dimensions plus rotation in the same plane (Klinger) .
• the first radiograph is stored in the computer's fixed disk drive using the full 256 (8 bits) gray levels of resolution. Registration of the second film to be compared is facilitated by continuously "grabbing" the image of the second radiograph while simultaneously displaying the subtraction between the first and second radiograph on the same video screen. Since slight variations in film processing or voltage to the X-ray tube may result in differences in contrast in the resultant films, the non-parametric gamma correction algorithm of Ruttiman (Rutti an, U.E. et al., J.Periodont.Res. (1986) 11:486) is used to correct differences in contrast between the two films. Registration is achieved when the video screen is a uniform gray and the anatomical structures such as teeth are not clearly discernible.
• the distance between the CEJ and the height of the alveolar crest is determined for the mesial and distal root surfaces.
• the alveolar bone height is taken either at the alveolar crest (for longitudinal bone loss) or at the point where the PDL space becomes indistinct (at the base of the apparent infrabony defects) .
• This measurement is converted for the magnification of the radiograph in the image processing system. Millimeters of bone loss at each site are determined from each radiograph.
• the radiographic images at 2 weeks are subtracted from the radiographs taken at baseline.
• Radiographs at 4 weeks are subtracted from the radiographs taken at baseline and so forth through 6 months. This provides multiple separate rates between each radiographic time interval (0, 0.5, 1, 1.5, 2, 2.5, 3, 4, and 6 months). Previous studies have shown that the error of this method in estimating bone loss is less than 0.08 mm on the original radiograph.
• Nuclear medicine techniques have been used to detect changes in bony metabolism (Jeffcoat, M.K. et al., Adv.Dent.Res. (1987), 1:80). Since changes in metabolism precede changes in architecture, nuclear medicine techniques can be used to detect osseous abnormalities before the changes can be seen on radiographs, and to predict bone loss or its inhibition which will subsequently be seen radiographically. In an animal model, nuclear medicine techniques are used to extend and amplify the radiographic measurements of the ligature induced periodontitis on bone resorption by measuring bone metabolism. The technique used is as follows: At the beginning of the study (Baseline) , both dogs are injected with 1.5 mCi/kg of 99 Tc-MDP intravenously.
• the alveolar bone uptake is measured.
• a cadmium telluride semi-conductor probe detector is used to obtain measurement of uptake about the first through fourth premolars of each quadrant in both dogs.
• the uptake measurement for each site is divided by the uptake measured at the bony prominence dividing the dorsal and posterior skull surfaces.
• the use of ratios corrects the data for differences in injected dose and biological and physical decay of radiopharmaceutical, thereby facilitating comparison of uptake data between animals.
• the uptake of the radiopharmaceutical at each study site is repeated.
• Figs. 1-4 which display data generated from gingival crevicular fluid (GCF) and peripheral blood samples collected from dogs following induction of periodontitis from baseline through 6 weeks and corresponding radiopharmaceutical uptake (Figure 3) .
• GCF gingival crevicular fluid
• Figure 3 corresponding radiopharmaceutical uptake
• Figure 4 demonstrates the effects of inductuion of periodontitis on circulating peripheral blood levels of ICTP Pyridinoline Cross-link.
• Periodontitis was induced around the teeth on one side of the mouth while the contralateral sides were maintained in periodontal health. Note significant increases at 6 weeks as compared to baseline (p( ⁇ .05). This illustrates that periodontitis elevates systemic ICTP pyridinoline cross- link levels as well as locally in the GCF (See Figure 1) .
• Other embodiments are within the following claims.

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• 1994
  • 1994-02-16 US US08/197,131 patent/US5516699A/en not_active Expired - Lifetime
• 1995
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